1Formulas and methods
Infection control & patient safety
Method
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
2Practice problems
1.Infection control & patient safetyMedium
When should blood specimen tubes be labeled?
- AAt the bedside, in front of the patient, right after collection
- BBy the laboratory staff after the tubes arrive
- CBack at the station after all the samples are collected
- DAt the nurses’ station before going to the patient, to save time
2.Infection control & patient safetyHard
A nurse has weeping dermatitis on both hands. What is the most appropriate action?
- ACover the lesions with a waterproof bandage and keep working with patients as usual
- BUse extra alcohol hand rub on the lesions
- CAvoid direct patient care and handling of equipment until it heals, and see occupational health
- DContinue care as usual and wear one pair of gloves
3.Nursing fundamentalsMedium
Which measure is appropriate for a patient with a fever who feels hot and uncomfortable?
- ALight bedclothes, plenty of fluids and a prescribed antipyretic
- BExtra blankets to make the patient sweat it out
- CRestricting fluids so the patient sweats less during the fever
- DAn ice bath until the patient shivers
4.Nursing fundamentalsHard
A pulse oximeter reads 82% on a patient with cold hands who is talking in full sentences with a normal respiratory rate. What is the best first action?
- ARecord the reading and recheck it at the next routine set of observations
- BCheck the patient and probe, then warm the hand or move the probe
- CIgnore the reading because the patient looks well
- DRemove any oxygen because the reading must be wrong
5.MicrobiologyMedium
What is endotoxin?
- AThe lipopolysaccharide in the outer membrane of Gram-negative bacteria
- BA protein toxin secreted by Gram-positive bacteria into the surrounding tissue
- CA toxin produced only inside human cells
- DA toxin made by fungi in damp buildings
6.MicrobiologyHard
A healthcare worker's blood test is positive for anti-HBs (hepatitis B surface antibody) and negative for HBsAg and anti-HBc. What does this most likely mean?
- APast natural infection that has cleared
- BCurrent acute hepatitis B infection
- CImmunity from hepatitis B vaccination
- DChronic hepatitis B infection
3Solutions
1.Infection control & patient safety
Answer: A · At the bedside, in front of the patient, right after collection
Why this is the answer
Labeling tubes at the bedside, using two patient identifiers and in the patient’s presence, prevents wrong-patient specimens. Pre-labeled or later-labeled tubes are easily mixed up.
A · At the bedside, in front of the patient, right after collection
2.Infection control & patient safety
Answer: C · Avoid direct patient care and handling of equipment until it heals, and see occupational health
Why this is the answer
Weeping skin lesions increase the risk of passing organisms to patients and of the nurse picking up bloodborne pathogens. The nurse should avoid direct patient contact and handling of patient equipment until the condition is assessed and resolved.
C · Avoid direct patient care and handling of equipment until it heals, and see occupational health
3.Nursing fundamentals
Answer: A · Light bedclothes, plenty of fluids and a prescribed antipyretic
Why this is the answer
Light clothing, fluids and antipyretics such as paracetamol (acetaminophen) increase comfort and replace fluid lost through sweating. Very cold sponging causes shivering, which produces heat.
A · Light bedclothes, plenty of fluids and a prescribed antipyretic
4.Nursing fundamentals
Answer: B · Check the patient and probe, then warm the hand or move the probe
Why this is the answer
Cold peripheries, movement and nail varnish can give falsely low readings. The nurse assesses the patient first, then checks the waveform and probe site; a low reading is never ignored until it is explained.
B · Check the patient and probe, then warm the hand or move the probe
5.Microbiology
Answer: A · The lipopolysaccharide in the outer membrane of Gram-negative bacteria
Why this is the answer
Endotoxin is lipid A of lipopolysaccharide. It triggers strong immune responses with fever and, in large amounts, septic shock.
A · The lipopolysaccharide in the outer membrane of Gram-negative bacteria
6.Microbiology
Answer: C · Immunity from hepatitis B vaccination
Why this is the answer
The vaccine contains HBsAg, so a vaccinated person makes anti-HBs but no anti-HBc. Past natural infection gives both anti-HBs and anti-HBc, and ongoing infection shows HBsAg.
C · Immunity from hepatitis B vaccination